Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2–3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.

Migraine was frequent in students in Cotonou (Benin) compared with other studies in Africa.

Background: The burden of stroke is high in sub-Saharan Africa (SSA), but few data are available on its long-term mortality. Objective: To estimate over one-month stroke case-fatality in sub-Saharan Africa Methods: Systematic review and meta-analysis was performed according to Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42020192439), on five electronic databases (PubMed, Science direct, AJOL, EMBASE and Web of Sciences). We searched all studies on stroke mortality case-fatality over one-month in SSA published between 1st January 2000 and 31 December 2019. Results: We included 91 studies with 34,362 stroke cases. The one-month pooled stroke case-fatality rate was 24.1% [95%CI: 21.5-27.0] and 33.2% [95%CI: 23.6-44.5] at 1-year. At 3 and 5-years the case-fatality rates were respectively 40.1% [95% CI: 20.8-63.0] and 39.4% [95%CI: 14.3-71.5] with high heterogeneity. Hemorrhagic stroke was associated with a higher risk of mortality at one month, but ischemic stroke increased the risk of mortality over 6 months. Diabetes was associated with poor prognosis at 6 and 12 months with odds ratios of 1.64 [95% CI: 1.22-2.20] and 1.85 [1.25-2.75] respectively. Conclusion: The stroke case-fatality over one-month was very high compared to other reported in Western countries and can be explained by the weak healthcare systems and vascular risk factors despite the high heterogeneity in this review.